Immediate Effect of Ankle Mobilization on Active Range of Motion and Gait in Subacute Stroke

NCT ID: NCT06109194

Last Updated: 2025-01-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-19

Study Completion Date

2024-06-10

Brief Summary

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The goal of this observational study is to determine the effect of ankle joint mobilization on active range of motion and gait in subacute first-time stroke. The main questions it aims to answer are:

* What is the effect of ankle joint mobilization on active range of motion in the ankle and gait qualities?
* What is the effect of ankle joint mobilization on self-perceived gait ability?

Participants will receive physical therapy interventions of:

* Grade III ankle joint mobilization
* stretching of ankle plantarflexor muscles
* ankle muscle activation training
* assisted gait as part of assessment

Study design is to measure conditions before and after the intervention to determine effect(s) of one treatment dose, completed within one session of 90 minutes.

Detailed Description

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Initial passive and active ankle range of motion measured by goniometer. Initial gait quality will be measured by walking with splinting for frontal plane ankle stability if indicated, assistive device for body weight support if needed, and manual assistance from an experienced physical therapist, on a Zeno Walkway pressure-sensitive mat for five complete stride cycles, taking 3 to 5 minutes. Data collected from the mat will be electronically captured using ProtoKinetics software. Participant initial self-rated perception of ability to walk will be marked on a 0-10 scale, on paper. Treatment intervention follows. With participant lying on the back, paretic ankle moderate-force grade III anterior to posterior-directed manual joint mobilizations will be performed by therapist; three sets of fifteen oscillations. Ankle plantarflexor muscles will be stretched for 75 seconds in supported standing. Ankle dorsiflexion muscle activation training will be performed for three minutes while in a seated position. Post-intervention measurements will proceed in the same sequence as initial measurements listed above: Ankle passive and active range of motion and walking ability will be reassessed, and self-perceived ability to walk will be rated again.

Conditions

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Hemiparesis;Poststroke/CVA

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

pre-test, intervention, post-test
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

No masking to occur

Study Groups

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Intervention

Pre-assessment of active and passive range of motion in the paretic ankle, and five strides of gait assessment on a pressure-sensitive mat. Intervention will be moderate grade III anterior-to-posterior directed ankle mobilization for 2 minutes while supine, ankle muscle stretch for 75 seconds in standing, ankle muscle training for 3 minutes while seated. Post-assessment is repeated in the same sequence and content as pre-assessment.

Group Type EXPERIMENTAL

Joint mobilization

Intervention Type OTHER

Grade III manual joint mobilization as standard-of-care physical therapy intervention

Interventions

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Joint mobilization

Grade III manual joint mobilization as standard-of-care physical therapy intervention

Intervention Type OTHER

Other Intervention Names

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manual therapy, tissue stretch

Eligibility Criteria

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Inclusion Criteria

* First stroke
* subacute phase after stroke
* able to follow one-step commands
* paretic passive ankle dorsiflexion less than 5 degrees

Exclusion Criteria

* ankle pain of undetermined cause at rest
* fracture in paretic lower extremity
* muscle or ligament tear
* recent ankle sprain
* skin tear or wound
* joint fusion or implanted hardware
Minimum Eligible Age

21 Years

Maximum Eligible Age

86 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Loma Linda University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Eric G Johnson, PT, DSc

Role: STUDY_CHAIR

Loma Linda University

Locations

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Loma Linda University Health

Loma Linda, California, United States

Site Status

Countries

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United States

References

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Kim SL, Lee BH. The Effects of Posterior Talar Glide and Dorsiflexion of the Ankle Plus Mobilization with Movement on Balance and Gait Function in Patient with Chronic Stroke: A Randomized Controlled Trial. J Neurosci Rural Pract. 2018 Jan-Mar;9(1):61-67. doi: 10.4103/jnrp.jnrp_382_17.

Reference Type BACKGROUND
PMID: 29456346 (View on PubMed)

An CM, Jo SO. Effects of Talocrural Mobilization with Movement on Ankle Strength, Mobility, and Weight-Bearing Ability in Hemiplegic Patients with Chronic Stroke: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis. 2017 Jan;26(1):169-176. doi: 10.1016/j.jstrokecerebrovasdis.2016.09.005. Epub 2016 Oct 17.

Reference Type BACKGROUND
PMID: 27765557 (View on PubMed)

An CM, Won JI. Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study. J Phys Ther Sci. 2016 Jan;28(2):689-94. doi: 10.1589/jpts.28.689. Epub 2016 Feb 29.

Reference Type BACKGROUND
PMID: 27065565 (View on PubMed)

Alamer A, Melese H, Getie K, Deme S, Tsega M, Ayhualem S, Birhanie G, Abich Y, Yitayeh Gelaw A. Effect of Ankle Joint Mobilization with Movement on Range of Motion, Balance and Gait Function in Chronic Stroke Survivors: Systematic Review of Randomized Controlled Trials. Degener Neurol Neuromuscul Dis. 2021 Sep 1;11:51-60. doi: 10.2147/DNND.S317865. eCollection 2021.

Reference Type BACKGROUND
PMID: 34512072 (View on PubMed)

Cho KH, Park SJ. Effects of joint mobilization and stretching on the range of motion for ankle joint and spatiotemporal gait variables in stroke patients. J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104933. doi: 10.1016/j.jstrokecerebrovasdis.2020.104933. Epub 2020 Jun 8.

Reference Type BACKGROUND
PMID: 32689617 (View on PubMed)

Kang MH, Oh JS, Kwon OY, Weon JH, An DH, Yoo WG. Immediate combined effect of gastrocnemius stretching and sustained talocrural joint mobilization in individuals with limited ankle dorsiflexion: A randomized controlled trial. Man Ther. 2015 Dec;20(6):827-34. doi: 10.1016/j.math.2015.03.016. Epub 2015 Apr 2.

Reference Type BACKGROUND
PMID: 25907146 (View on PubMed)

Gao F, Ren Y, Roth EJ, Harvey R, Zhang LQ. Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors. Clin Biomech (Bristol). 2011 Jun;26(5):516-22. doi: 10.1016/j.clinbiomech.2010.12.003. Epub 2011 Jan 6.

Reference Type BACKGROUND
PMID: 21211873 (View on PubMed)

Forghany S, Nester CJ, Tyson SF, Preece S, Jones RK. The effect of stroke on foot kinematics and the functional consequences. Gait Posture. 2014 Apr;39(4):1051-6. doi: 10.1016/j.gaitpost.2014.01.006. Epub 2014 Jan 31.

Reference Type BACKGROUND
PMID: 24548798 (View on PubMed)

Mirbagheri MM, Alibiglou L, Thajchayapong M, Rymer WZ. Muscle and reflex changes with varying joint angle in hemiparetic stroke. J Neuroeng Rehabil. 2008 Feb 27;5:6. doi: 10.1186/1743-0003-5-6.

Reference Type BACKGROUND
PMID: 18304313 (View on PubMed)

Shorter AL, Richardson JK, Finucane SB, Joshi V, Gordon K, Rouse EJ. Characterization and clinical implications of ankle impedance during walking in chronic stroke. Sci Rep. 2021 Aug 18;11(1):16726. doi: 10.1038/s41598-021-95737-6.

Reference Type BACKGROUND
PMID: 34408174 (View on PubMed)

Forrester LW, Wheaton LA, Luft AR. Exercise-mediated locomotor recovery and lower-limb neuroplasticity after stroke. J Rehabil Res Dev. 2008;45(2):205-20. doi: 10.1682/jrrd.2007.02.0034.

Reference Type BACKGROUND
PMID: 18566939 (View on PubMed)

Simpson DB, Breslin M, Cumming T, de Zoete SA, Gall SL, Schmidt M, English C, Callisaya ML. Sedentary time and activity behaviors after stroke rehabilitation: Changes in the first 3 months home. Top Stroke Rehabil. 2021 Jan;28(1):42-51. doi: 10.1080/10749357.2020.1783917. Epub 2020 Jun 24.

Reference Type BACKGROUND
PMID: 32578523 (View on PubMed)

Other Identifiers

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5230164

Identifier Type: -

Identifier Source: org_study_id

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